Adverse Childhood Experiences and Developmental Health of Children Attending Community Paediatric Clinics in South Western Sydney

Shanti Raman,Yuanee Wickramasinghe,Pankaj Garg,Romy Hurwitz
South Western Sydney Local Health District

Background : Adverse childhood experiences (ACE) are associated with poor short, medium and long-term health outcomes. South Western Sydney (SWS) has a large culturally and linguistically diverse population, including many disadvantaged sub-populations. Since 2017 a modified ACE checklist has been used in all SWS Community Paediatric (CP) clinics. Our aims were to determine the burden of ACE and describe the developmental health of children attending these clinics, in order to facilitate early intervention.

Material : Data was collated from ACE checklists completed within CP clinics, including child development (CD) and vulnerable child (VC) clinics between February 2017 and August 2017. Demographic information, developmental and chronic health conditions, and ACE risks were entered into an Excel spreadsheet, descriptive analysis was performed using SPSS.

Results : Of 279 children seen, 167 (60%) attended CD clinics, 112 (40%) attended VC clinics. Seventy-eight (28%) had ACE ?4 and 178 (64%) had ACE ?1. Of those attending CD clinics, 8 (5%) had ACE ?4 compared to 70 (63%) attending VC clinics (p<0.001). Of children with ACE ?4, 24 (31%) were of Anglo-Australian background and 21 (27%) were of Indigenous background. The highest number of children with ACE ?4 were 0 to <5 years of age (n= 34), however, the greatest proportion was in children ?15 years of age (73%); significant association between age group and ACE ?4 (p<0.001). There was no significant association between ACE ?4 and developmental health, however, children attending all CP clinics had a range of developmental and chronic health conditions.

Conclusions : Children attending community clinics in SWS have a high burden of ACE and health and developmental problems. Children attending specialised clinics for vulnerable children and youth, those of Indigenous background and of an older age group, had the highest burden of ACE. Our findings support the need for specialised pathways for paediatric assessment and care for vulnerable, at-risk children.